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Individual
SE J PARK
Active
Individual
SE J PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C, DNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95023379
CA
363L00000X
Nurse Practitioner
RN243386
GA
363LG0600X
Gerontology Nurse Practitioner
95023379
CA
363LG0600X
Gerontology Nurse Practitioner
RN243386
GA
Other
Enumeration date
02/02/2017
Last updated
10/30/2025
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